Recurrent Giant Hemangioma Causing Severe Respiratory Distress

Abstract

Hemangioma is a common benign tumor of the liver that is usually asymptomatic. If >4 cm (giant hemangioma), it could present symptoms related to bleeding, thrombosis, consumptive coagulopathy, or adjacent abdominal organ compression. If symptomatic surgical treatment should be considered, liver resection as well as enucleation are considered. Recurrences after surgical resection are rare. We herein present a case of woman admitted to the emergency room for acute severe respiratory distress. She had undergone 2 surgical resections of liver hemangiomas. The respiratory syndrome, as showed by chest x-ray, computed tomography scan, and nuclear magnetic resonance imaging, was related to a recurrent giant multiple hemangioma, creating a prominent compression of right lung with left mediastinal shift and left heart dislocation. It resulted in pulmonary parenchymal compression associated with reduced chest wall compliance and increased pulmonary pressure. The patient was not eligible for surgical treatment because of the disease extension and her clinical conditions. She died 6 months later from respiratory insufficiency and hypercapnic coma.

Recurrent giant hemangiomas of liver: Report of two rare cases with literature review

“…To date, there are only five reported cases (four women and one man) of hemangiomas that have recurred, with average time of recurrence of 14 years (11 years to 17 years) [6,9] ( Table 1). It has been suggested that recurrent tumors are probably due to the result of growth of new cellular tissue instead of earlier suggestions of vascular ectasia [1,8] .…”

“…Tumor recurrence after liver resection is extremely rare and the underlying mechanism is still poorly understood. Steroids and sex hormones have been speculated to be associated with tumor progression [5][6][7][8][9] . Here, we report two unique cases of recurrent hemangiomas after liver resection.…”

Resection of a rapid-growing 40-cm giant liver hemangioma

“…Most hemangiomas are asymptomatic and therefore largely diagnosed only in routine screening tests. Usually they are small and require no specific treatment [1][2][3][4][5] . In some situations they can reach great dimensions, causing some discomfort to the patient.…”